Electronic Health Record-Integrated Clinical Decision Support for Clinicians Serving Populations Facing Health Care Disparities: Literature Review

Abstract

Objectives: To review current studies about designing and implementing clinician-facing clinical decision support (CDS) integrated or interoperable with an electronic health record (EHR) to improve health care for populations facing disparities. Methods: We searched PubMed to identify studies published between January 1, 2011 and October 22, 2021 about clinician-facing CDS integrated or interoperable with an EHR. We screened abstracts and titles and extracted study data from articles using a protocol developed by team consensus. Extracted data included patient population characteristics, clinical specialty, setting, EHR, clinical problem, CDS type, reported user-centered design, implementation strategies, and outcomes. Results: There were 28 studies (36 articles) included. Most studies were performed at safety net institutions (14 studies) or Indian Health Service sites (6 studies). CDS tools were implemented in primary care outpatient settings in 24 studies (86%) for screening or treatment. CDS included point-of-care alerts (93%), order facilitators (46%), workflow support (39%), relevant information display (36%), expert systems (11%), and medication dosing support (7%). Successful outcomes were reported in 19 of 26 studies that reported outcomes (73%). User-centered design was reported during CDS planning (39%), development (32%), and implementation phase (25%). Most frequent implementation strategies were education (89%) and consensus facilitation (50%). Conclusions: CDS tools may improve health equity and outcomes for patients who face disparities. The present review underscores the need for high-quality analyses of CDS-associated health outcomes, reporting of user-centered design and implementation strategies used in low-resource settings, and methods to disseminate CDS created to improve health equity.

Clinical Decision Support Systems: Contributions from 2021

“…This paper serves as the synopsis of the Decision Support section of the International Medical Informatics Association (IMIA) Yearbook. This synopsis complements the review paper authored by Stipelman et al, where the authors performed a literature review to identify studies focusing on the design and implementation of clinician-facing clinical decision support (CDS) tools to improve health care for populations facing disparities [1]. Therefore, the aim of the synopsis is to summarize recent research in the domain of interest and to select the best papers published in this field in 2021.…”

Applying Machine Learning Techniques to Implementation Science

“…Finally, it is critically important to develop and validate models with equity in mind. Many of the algorithms developed in medicine are based on trials with nonrepresentative samples [ 60 ]. A recent publication examining various race-biased algorithms used for medical risk predictions demonstrated the potentially harmful consequences of biased algorithms [ 61 ].…”

Lessons Learned from a National Initiative Promoting Publicly Available Standards-Based Clinical Decision Support

“…9 Developing and implementing EHR-agnostic CDS requires use of standards and resources that either allow for CDS knowledge artifact integration and execution within EHR systems, or support CDS use as a service that exchanges patient data with the EHR. 10,11 See ►Table 1 for description. 12,13 Only two publicly available repositories make EHR-agnostic CDS artifacts and resources freely available.…”